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   Table of Contents - Current issue
October-December 2020
Volume 28 | Issue 4
Page Nos. 199-254

Online since Monday, September 28, 2020

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Academic promotion criteria: Success or fail? p. 199
Cenk Demirdover
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Effect of long-term intermittent hypothermia on random skin flap viability and new vessel formation p. 200
Ibrahim Baris Caglar, Burak Ozkan, Abbas Albayati, Ahmet Cagri Uysal, Nilgun Markal Ertas
Background: Preconditioning is the improving the overall viability of the flaps before surgery. Hypothermia is one of preconditioning methods. In literature, the effect of short time hypothermia in skin flap viability has been studied. However, there is no information about the effects of long-term application of hypothermia on skin flap viability. In this study, we investigated the effect of long-term local hypothermia on flap viability and new vessel formation on random pattern skin flaps. Materials and Methods: Thirty-six adult male Sprague-Dawley rats were used. The flap model was, 3 cm × 9 cm sized random pattern skin flap. Three groups were composed as control group, continuous hypothermia induction group with ice bags, and intermittent hypothermia induction with chloroethyl spray. Flaps were raised on the 15th day of hypothermia sessions. Flap viability was measured in the software program. Microangiography and blood vascular endothelial growth factor (VEGF) levels were assessed for the detection of new vessel formation. Results: Average flap viabilities were found to be 64.87% in Group I, 57.69% in Group II, and 62.22% in Group III. The difference between Group II and other groups were statistically significant. When microangiographies were examined macroscopically, diameters, and amount of vascular branches of vessels in Group II were found to be higher than other groups. The difference between blood VEGF levels day 1 values among groups was not statistically significant. When day 4 values were compared to baseline values difference in Group III was statistically significant. At days 7 and 15, differences between groups and corresponding baseline values were not statistically significant. Conclusion: Continuous long-term application of hypothermia with ice-water bags causes a significant increase in neovascularization in random pattern skin flaps without an increase in skin flap viability. Hence, we can say that 2 weeks of hypothermia on random pattern skin flaps is not an efficient preconditioning method in clinical use.
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Dye laser and long-pulsed Nd: YAG laser treatment of vascular lesions: Clinical experience p. 205
Ali Gokkaya, Metin Gorgu
Introduction: Hemangiomas and vascular malformations are common vascular lesions. Although various methods have been described in the treatment of vascular lesions, the place of lasers is very important. Today, dye laser and Nd: YAG lasers are most commonly used in the laser treatment of vascular lesions. Materials and Methods: A total of 137 patients treated with 585–600 nm flashlamp pulsed dye laser and 1064-nm long-pulsed Nd: YAG laser in three laser units were searched, and laser setups and the number of sessions used were evaluated. Evaluations were made by three plastic surgeons over photographs. According to the discoloration and decrease in height of the lesion, it was classified as 0%–25% (poor), 25–50 (average), 50–75 (good), and 75–100 (excellent). The age of the patients ranged from 2 months to 55 years. 53 port-wine stain, 18 telangiectasia, 8 cherry angioma, 12 spider angioma, 18 hemangioma, 8 venous lake, 11 intraoral hemangioma, and 9 other vascular lesions constituted the distribution of diagnoses between patients. Laser power used in dye laser treatments ranged between 7 and 19 J/cm2, the mean sequence was 6.4, and duration ranged between 1.5 and 20 msec. Nd:YAG l laser power ranged between 120 and 240 J/cm2, the mean sequence was 2.8, and duration ranged between 10 and 50 msec. Results: Seventy patients (51.1%) achieved excellent results, 32 patients (23.36%) achieved good results, 14 patients (10.21%) achieved average clearance, and 21 patients (15.33%) showed low or no removal of their lesion. High success was achieved with minimal complications. Conclusion: Today, dye laser and Nd: YAG lasers provide a satisfactory aesthetic result, low morbidity, and effective treatment for many vascular lesions in terms of patient comfort. In order to optimize results and reduce negative effects, it is necessary to master the properties of the laser and have sufficient knowledge of the interactions of the laser with tissue.
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Role of perforator flaps in meningomyelocele defect repair p. 214
Necip Sefa Ozden, Burak Kaya, Gokmen Kahilogullar
Background: With an incidence of 1–2 in 1000 live births, meningocele is a relatively frequent birth defect. The lumbosacral region is affected in threequarters of the cases. It may lead to urinary and fecal incontinence, as well as plegia or paresis in the lower extremity. A large number of techniques have been described for meningomyelocele defect repair. Aims and Objectives: We reviewed perforator flaps used in meningomyelocele defect repair on patients admitted to our clinic and compared it with literature. Materials and Methods: This study included 12 newborns operated between January 2012 and February 2019. Results: The meningomyelocele was located in the thoracolumbar area in five patients and the lumbosacral area in 7 patients. The patients weights were 1830–3800 g. The most commonly used flap was the superior gluteal artery flap (n:5). Other flaps that were commoly used are the dorsal intercostal artery perforator (DIAP) and the lumbar artery perforator flaps. In two patients CSF leak was seen and one patient distal necrosis was seen. Conclusion: Perforator flaps can be used safely with a relatively low complication rate in meningomyelocele defect repair. It seems to be an alternative for safe, rapid, less bleeding, and easy surgery resulting in a solution for the closure of large meningomyelocele defects.
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New combinations of threads with surgical methods for facial rejuvenationnew combinations of threads with surgical methods for facial rejuvenation p. 219
Naci Celik
Background: Surgical rejuvenation of the face is popular in esthetic surgery. Thread-lift techniques became more popularized in recent years. On the other hand, most of the plastic surgeons still prefer classical surgical face-lift methods because of the superiority of the results. Materials and Methods: Between March 2018 and June 2019, 14 patients were operated with a combination of threads and other surgical methods including fat injection, blepharoplasty, subcutaneous radiofrequency with Cool Atmospheric Plasma J-plasma, and gliding temporal lift with surgical net for facial rejuvenation. For thread lifting, a relatively new type of nonabsorbable suture that is made of polyester and silicone is used in this study. Results: All patients healed uneventfully. One patient had a temporary weakness of buccal branch of the facial nerve. Discussion: It is obvious that the esthetical results of classical face-lift methods are far more superior than those of thread-lift methods. On the other hand, the complications of threads are less likely and easily manageable. Besides, more and more patients request doctors to do thread lifts. Conclusion: The author thinks that more plastic surgeons should contemplate to introduce the threads into their practice since many other nonplastic surgeons offer thread lift as a substitute for face-lift. This is a myth. However, we cannot deny the growing number of patients who are looking for an easier and scar-free way of face-lift with a less downtime. These types of combinations, revealed in this study, allow plastic surgeons to achieve better results compared with the thread lifts alone while reducing the complications and offering a faster healing period than the classical face-lift methods.
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Favorable long-term esthetic, functional, and sensory outcome and preferability of distal digital replantations p. 224
Ayhan Okumus
Background: To evaluate long-term esthetic, functional, and sensory outcome and preferability of distal digit replantations with respect to contralateral intact finger. Materials and Methods: A total of 63 single-or multi-digit clean cut amputations distal to distal interphalangeal joint (DIPJ) involving nail fold in 45 consecutive patients (mean 29 years, 26 males, 19 females) who underwent replantation surgery between 2010 and 2016 were included in this study. Esthetic outcome, functional, and sensory outcome were assessed in the postoperative 6 months, 1 year, and 3 years. Results: Single-digit amputation was noted in 34 patients including thumb (n = 9), index finger (n = 10), middle finger (n = 7), ring finger (n = 7), and little finger (n = 1). Multi-digit amputations were evident in 11 patients involving 2 fingers in five patients (index + middle in two patients, middle + ring in two patients, and thumb + index in one patient), 3 fingers in five patients (index + middle + ring in 4 patients and middle + ring + little in one patient), and 4 fingers in one patient (index + middle + ring + little). All patients were operated within the first 4 h of hospital admission. Postoperative 3-year outcome was excellent in 79.3% of operations, good in 14.2%, and acceptable in 6.3% of operations. None of the operations resulted in poor or very poor outcome and none of the patients had functional loss during the entire follow-up period. A very satisfactory sensory outcome with static two-point discrimination test findings of <6 mm was noted in all operations involving nerve repair, while in operations without nerve repair, the sensory outcome was also moderately satisfactory. Conclusion: Our findings indicate excellent long-term esthetic, functional, and sensory outcomes of distal digit replantation. Our findings emphasize consideration of replantation in single-level clear-cut distal digit amputations without avulsion or crush injury as a technique associated with excellent esthetic long-term outcomes.
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Medical and cosmeceutical applications for enhancement of partial-thickness skin graft donor-site healing p. 231
Galip Gencay Ustun, Figen Ozgur, Sueda Hekimoglu
Introduction: After partial-thickness skin graft (PTSG) harvesting, a dermal surface is exposed and an iatrogenic wound is created. Application of various agents has been studied for enhancement of healing process in PTSG donor area. The ideal agent should accelerate healing, provide comfort to the patient, not allow infection, and be easily applicable and cheap. Materials and Methods: The Cochrane Central Register of Controlled Trials, PubMed, Scopus. and EMBASE databases were screened for words (“skin graft” + “donor”), by using time limits between 1989 and 2018. This study involved a total of 5 systematic reviews and 43 original articles which met the inclusion criteria. Articles were reviewed and parameters such as healing time, pain, infection rate, cosmetic result, and cost were extracted. Results: Systematic reviews favor moist dressing materials over dry ones considering healing time and patient comfort. Hydrocolloids provide rapid wound healing, and dressing changes do not cause any disruption to the newly regenerated epithelium. Alginates seem to have a longer healing time than hydrocolloid materials. Polyurethane films are characterized by rapid epithelialization and painless monitoring as well as low costs. The epithelialization time of MEBO®, a cosmeceutical product, is reported to be faster than polyurethane films. Local and systemic drug applications warrant further research before routine clinical usage. Conclusion: Dressing materials are the most commonly used and appropriate group according to the studies performed to date. It is seen that moist dressing materials are more favorable. Although there is not a subgroup with a clear superiority, it can be seen that the hydrofiber and polyurethane film groups are one step ahead in terms of ease of use, patient comfort, epithelialization speed, and scar quality. Polyurethane films have a cost advantage to the hydrofiber group.
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Hair-Thread tourniquet syndrome: Two case reports p. 237
Mustafa Sutcu, Gokce Yildiran, Osman Akdag
Hair-thread tourniquet syndrome is wrapping of hair or similar material that straps around and strangulates the limbs such as fingers or toes. This syndrome is a pediatric emergency and is a serious condition that can cause limb necrosis. In this report, we aimed to present two cases of hair-thread tourniquet syndrome. Case 1 was an 8-week-old female infant who had edema and ecchymosis on the third finger. Edema and ecchymosis regressed after the removal of hair. Case 2 was a 2-week-old baby boy who had developed a strangulation in the deep plan of the second and third fingers. After 2 days of hair removal, edema and ecchymosis regressed. Hair-thread tourniquet syndrome is a pediatric emergency and may cause finger or toe necrosis. Its treatment is simple and it is a differential diagnosis that should be kept in mind in strangulated organs.
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Reconstruction of postsurgical mandibular defect (keratocystic odontogenic tumor) by transport distraction osteogenesis p. 240
S Devakumari, Neil Dominic
Reconstruction of mandibular surgical defects often poses a great challenge to maxillofacial surgeons. Mandibular segmental defects majorly disrupt the occlusion, mastication, and the facial esthetics. Free autografts such as iliac crest and rib; allografts such as three-dimensional, bendable reconstruction plate; and patient-specific implant are some of the techniques that had been employed for the reconstruction of such defects. Nevertheless, in recent times, the most dependable modes of reconstruction are the microvascular fibula reconstruction and transport distraction techniques. Transport distraction osteogenesis (TDO) is a reliable technique without donor-site morbidity especially in the dentate region of the mandible as it provides native bone for rehabilitation. The aim of this article is to report a successful case of TDO to fill the defect in the left body of the mandible secondary to segmental resection of the mandible for keratocystic odontogenic tumor. The technique was successful with a 2-year follow-up period without any potential esthetic compromise.
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Palmar vertical hemi-hand amputation: A rare form of amputation p. 244
Ayhan Okumus
The patient presented in this study was admitted to our clinic with an uncommon injury as a result of the accidental insertion of his hand in a rope winding machine at a textile factory. A 26-year-old male patient was responsible for the control of a rope wrapping machine at a textile factory. While working, the employee's left hand was injured by making contact with the running machine. He had no problem with the dorsal aspect of his hands, but the volar examination revealed a soft-tissue defect on his wrist flexor line from the pulp level. The defect contained more than the palmar half of the hand's lateral width and all structures were amputated in the impaired manner. The patient was treated with a sensory inguinal flap and two-stage flexor tendoplasty. He is now able to perform routine daily tasks such as hand gripping, holding a pencil, buttoning buttonholes, and dressing.
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Giant pilomatrixoma revisited p. 248
Aydan Ayse Kose, A Emre Kocman
Pilomatrixoma is a common benign tumor of childhood; however, the correct diagnosis is rare. The fast-growing, giant pilomatrixomas frequently confused with some other malign conditions necessitating excess workup and over surgeries. The aim of this review is to identify the specific presenting complaints of the patients, clinical and radiological findings. A 13-year-old adolescent male patient was presented with a rapidly growing, large, solid cheek mass. The mass was removed from an intraoral mucosal incision. Although the patient had an infection after the surgery, the postoperative course was otherwise unremarkable, and the patient had no incision scar on the cheek. The initial diagnosis for rapidly growing masses is generally infection and malignity. When the presurgical diagnostic tests are not interpretational, total extirpation and pathological examinations are necessary. Pilomatrixoma, as a very common benign childhood tumor, has specific clinical features that may remind the entity to the physician. During the diagnosis of fast-growing, painless, large masses of head, neck, and upper extremities, pilomatrixoma should be among the differential diagnosis. By looking for the tent and seesaw signs, one can avoid the unnecessary workup for pilomatrixoma.
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Role of trapezius turnover flap in complex posterior cervical wounds p. 252
Bilgen Can
The trapezius turnover muscle flap is a very useful and effective solution for complex wounds in the posterior cervical area after neurosurgical interventions. However, it is one of underused flaps in plastic surgery practice. The trapezius flap should be considered as the first choice when regional fasciocutaneous flap options are unavailable after radiotherapy and when patients are unsuitable for long-term microsurgical tissue transfer operations due to their age and general condition. The protection of the upper 1/3rd of the trapezius muscle during elevation of the flap could prevent the development of a drooping shoulder.
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